Real-world Impact of Age at Diagnosis on Treatment Patterns and Survival Outcomes of Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Abstract

Background Sixty-eight percent of patients with pancreatic ductal adenocarcinoma (PDAC) are 65 years and older. Older adults are under-represented in clinical trials and their care is complicated with multiple age-related conditions. Research suggests that older patients can experience meaningful responses to treatment for PDAC. The objective of this study was to evaluate the characteristics, rate of treatment, and survival outcomes of patients with metastatic PDAC (mPDAC) based on age at diagnosis. Materials and Methods Data were extracted for patients diagnosed with mPDAC between January 1, 2015, and March 31, 2020, from the Flatiron Health database. Patients were stratified into 3 age groups: <70 years old, 70-79 years, and ≥80 years. The proportion of patients who received first-line therapy, the types of regimens received in the metastatic setting, overall survival (OS) from the start of treatment were evaluated. Results Of the 8382 patients included, 71.3% (n = 5973) received treatment. Among patients who received treatment 55.5% (n = 3313) were aged <70 years at diagnosis, 33.0% (n = 1972) were 70-79 years, and 11.5% (n = 688) were ≥80 years. Patients ≥80 years of age were more likely to receive gemcitabine monotherapy and less likely to receive FOLFIRINOX. Among first-line treated patients, median OS significantly decreased with age. However, when comparing patients treated with the same first-line regimen, no significant differences in median OS were observed by age. Conclusions This study highlights that older adults with mPDAC can benefit substantially by receiving appropriate levels of treatment.

Treatment Patterns in US Patients Receiving First-Line and Second-Line Therapy for Metastatic Pancreatic Ductal Adenocarcinoma in the Real World

“…Notably, first-line targeted therapy yielded the lowest median overall survival (170 days, 5.6 months), further suggesting that effective targeted treatment for mPDAC does not exist in a real-world setting. These findings are generally in line with the previously reported age-group-specific first-line survival outcomes as published by Elias et al [ 10 ], demonstrating the overall lack of effective treatment options for patients with mPDAC.…”

“…In comparison with the study by Elias et al [10], which found that 38% of patients will receive a second line of therapy after their firstline treatment, we found that 46% of treated patients receive more than one line of therapy. However, what treatments are utilized in the second line has not been described by Elias et al We found that more patients received treatment with a nonstandard combination chemotherapy in the second line (35%) compared with the first line of therapy (11%).…”

“…Although this is a higher number compared with our findings, their analysis does not consider clinical study drugs as a separate treatment group, it is unclear what proportion of patients in their sample received treatment in an academic setting, and there may have been changes in clinical practice over time. A study on real-world treatment patterns in the USA by Elias et al found that first-line treatment differed by patient age, with older patients being more likely to receive monotherapy rather than combination chemotherapy [ 10 ]. Although they only provide treatment utilization by age group, they used the same database to identify their 2015–2020 sample and the identified trends were similar to those identified in the current study [ 10 ].…”

“…A study on real-world treatment patterns in the USA by Elias et al found that first-line treatment differed by patient age, with older patients being more likely to receive monotherapy rather than combination chemotherapy [ 10 ]. Although they only provide treatment utilization by age group, they used the same database to identify their 2015–2020 sample and the identified trends were similar to those identified in the current study [ 10 ]. In Japan, patients with unresectable and recurrent PDAC diagnosed in 2009 were found to be most likely (62%) to receive gemcitabine as first-line chemotherapy [ 14 ].…”

“…There is a scarcity of observational studies that describe treatment patterns and corresponding clinical and economic outcomes for advanced (nonresectable or metastatic) pancreatic cancer in routine care, and evidence on second-line treatment utilization and outcomes is lacking. This represents an important evidence gap, because 38% of patients are expected to start second-line systemic treatment after first-line treatment, which is even higher at 43% for patients younger than 70 years [ 10 ]. Furthermore, patterns of switching to second-line treatment based on first-line treatments, as well as differences in first-line treatment utilization and outcomes between patients who discontinue treatment overall and those who switch to a second-line treatment, have not been described.…”